Heparin-induced thrombocytopenia differential diagnosis

Heparin-induced thrombocytopenia
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Heparin-induced thrombocytopenia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Heparin-induced thrombocytopenia differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Heparin-induced thrombocytopenia differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Heparin-induced thrombocytopenia differential diagnosis
CDC on Heparin-induced thrombocytopenia differential diagnosis
Heparin-induced thrombocytopenia differential diagnosis in the news
Blogs on Heparin-induced thrombocytopenia differential diagnosis
Directions to Hospitals Treating Heparin-induced thrombocytopenia
Risk calculators and risk factors for Heparin-induced thrombocytopenia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

Heparin-induced thrombocytopenia is diagnosed when the platelet count falls by > 50% typically after 5-10 days of heparin therapy. It should be differentiated by other causes of thrombocytopenia like hemolytic uremic syndrome, Thrombotic thrombocytopenia and others.

Differential diagnosis

Diagnosis of Heparin-induced thrombocytopenia is mainly done with the help of lab tests. A decrease in platelet count by > 50% typically after 5-10 days of heparin therapy leads to a diagnosis of HIT. Thus, it should be differentiated from other causes of thrombocytopenia like

• Disseminated Intravascular Coagulation
• Thrombotic Thrombocytopenic Purpura
• Hemolytic-Uremic Syndrome
• Immune Thrombocytopenic Purpura
• Drug-Induced Thrombocytopenia
• Posttransfusion Thrombocytopenia
• Systemic Lupus Erythematosus

The table below summarizes the different findings between HIT and other diseases in the differential diagnosis:

Characteristic/Parameter	HIT	DIC	HUS	ITP	PTP	SLE
Symptoms	Bleeding, thrombosis, skin necrosis.	Bleeding, thrombosis, petechiae, sepsis.	Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia.	Petechiae, bleeding, other autoimmune diseases.	Petechiae, purpura, ecchymoses.	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis.
Platelet count	Low but usually more than 20000 per microliter.	Low.	Low.	Low; can be as low as 10000 per microliter.	Low; can be less than 10000 per microliter; sudden onset after transfusion.	Variable; usually low.
PT and PTT	Does not change the pain	Can increase the pain
Systemic systems	Pain is worse supine or upon inspiration (breathing in)	Not positional
Drug-related	Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER	Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER
Bleeding	Does not change the pain	Can increase the pain

Table legend: HIT, heparin-induced thrombocytopenia; DIC, disseminated intravascular coagulation; HUS, hemolytic-uremic syndrome; ITP, immune thrombocytopenia purpura; PTP, post-transfusion purpura; SLE, systemic lupus erythematosis